Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

Fischer, Laura E.; Wolfe, Bruce M.; Fino, Nora; Elman, Miriam R.; Flum, David R.; Mitchell, James E.; Pomp, Alfons; Pories, Walter J.; Purnell, Jonathan Q.; Patti, Mary‐Elizabeth; Berk, Paul D.; Bessler, Marc; Daud, Amna; Lobdell, Harrison; Mwelu, Jemela; Schrope, Beth; Ude, Akuezunkpa; Honohan, Jamie; Capasso, Michelle; Costa, Ricardo; Dakin, Greg; Ebel, Faith; Gautier, Michel; Hsieh, Jane; Strain, Gladys; Bowden, Rita C.; Chapman, William H.; Cundiff, Blair; Ball, Mallory; Cunningham, Emily; Dohm, Lynis; Pender, John R.; Barker, J.A.; Howell, Michael D.; Garcı́a, Luis; Lancaster, Kathryn E.; Lovaas, Erika; Monson, Tim; Cassady, Chelsea; Coburn, Emily; Moher, Emily; Deveney, Clifford W.; Elder, Katherine A.; Greene, Stefanie; O’Rourke, Robert W.; Sorenson, Chad; Patterson, Emma; Raum, William J.; VanDerWerff, Lisa; Kwiatkowski, Jason; Courcoulas, Anita P.; Gourash, William; McCloskey, Carol; Ramanathan, Ramesh; Kalarchian, Melissa A.; Marcus, Marsha D.; Shirley, Eleanor; Turo, Angela; Dellinger, E. Patchen; Khandelwal, Saurabh; Stewart, S; Cooley, Morgan M.; Blissell, Rebecca; Miller, Megan; Thirlby, Richard C.; Chang, Lily; Hunter, Jeffrey A.; Moonka, Ravi; Ng, Debbie M.; Belle, Steven H.; King, Wendy C.; Martin, Debbie; Mercurio, Rocco; Wahed, Abdus S.; Averbach, Frani; Horlick, Mary; Miles, Carolyn W.; Staten, Myrlene A.; Yanovski, Susan Z.; Kleiner, David E.

doi:10.1016/j.soard.2021.04.021

Cited by 16 publications

(7 citation statements)

References 49 publications

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“…Our patient was using insulin before the operation and did not describe symptoms of hypoglycemia. After she lost weight, she was no longer "protected" by insulin resistance, which was likely a result of her obesity-induced resistance to the extra insulin her tumor was producing [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Insulinoma Misdiagnosed as Post-bariatric Hypoglycemia: A Case Report and Review of the Literature

Teke¹,

Güneş²,

Aydın³

et al. 2023

Cureus

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Hypoglycemia is seen with increasing frequency after bariatric surgery. After the diagnosis of hypoglycemia has been clarified, malnutrition, drugs, hormone deficiencies, insulinoma, extra-islet tumors, post-bariatric hypoglycemia (PBH), early or late dumping syndrome, and nesidioblastosis should be considered in the differential diagnosis. A few case reports of insulinomas presenting after bariatric surgery have been reported in the literature. The coexistence of insulinoma and type 2 diabetes mellitus (T2D) is very rare. We herein report a clinical case of insulinoma presenting with severe hypoglycemia in a patient with a history of gastric transit bipartition. A patient with type 2 diabetes mellitus underwent gastric transit bipartition surgery due to the inability of medical therapy to provide adequate hyperglycemia control. After the operation, hypoglycemic symptoms appeared, and a reversal operation was performed, considering the diagnosis as PBH. After the reverse operation, the patient's hypoglycemia symptoms did not regress. The patient was admitted to our endocrinology clinic due to the persistence of hypoglycemia and symptoms such as fatigue, palpitation, and syncope. The patient's detailed anamnesis was examined, additional tests were performed, and the patient was diagnosed with insulinoma. The symptoms of hypoglycemia and the need for treatment for diabetes mellitus disappeared after the Whipple operation. This is the first case of insulinoma after gastric transit bipartition and subsequent reversal operations. In addition, the patient's diagnosis of diabetes mellitus makes this case unique. Although this is a very rare case, clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.

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Section: Discussionmentioning

confidence: 99%

Insulinoma Misdiagnosed as Post-bariatric Hypoglycemia: A Case Report and Review of the Literature

Teke¹,

Güneş²,

Aydın³

et al. 2023

Cureus

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“…En cuanto al tratamiento de esta afección, gran parte de los pacientes con síntomas moderados a leves de hipoglucemia pueden responder ante una modificación en la dieta (6) . Los pacientes que no responden favorablemente a una dieta baja en hidratos de carbono de fácil absorción pueden tratarse con verapamilo, diazóxido o inhibidores de la alfa-glucosidasa (12) . Cuando este tratamiento médico no causa mejoría como en el presente caso y existen síntomas severos, se recomienda una pancreatectomía total o parcial (6,7,10) .…”

Section: Discussionunclassified

Caso de hipoglicemia severa posterior a desviación gástrica en una mujer con enfermedad por esteatosis hepática no alcohólica (EHGNA)

Miranda

2022

Horizmed

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La hipoglucemia posterior la desviación gástrica se caracteriza por hipoglucemia posprandial con hipertrofia de las células de los islotes pancreáticos en pacientes tras someterse a una cirugía bariátrica, en quienes la EHGNA, la obesidad y la secreción alterada de la insulina y del glucagón pueden predisponerlos a presentar hipoglucemia. Se presenta el caso de una paciente de 44 años con obesidad y EHGNA sometida a una desviación gástrica en Y de Roux, quien años después presentó hipoglucemia severa. Fue diagnosticada de hipoglicemia por hiperinsulinismo endógeno con histología de hiperplasia de células beta. La hipoglicemia posterior a una desviación gástrica es un escenario que se afrontará más a menudo, por tal razón, es importante tenerla en cuenta para un tratamiento oportuno.

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“…Patients with PBH are susceptible to behavioral changes that aim to correct or avoid hypoglycemia, which result in weight regain [ 24 ]. Fischer et al [ 25 ] reported that the presence of symptoms of preoperative hypoglycemia is the most significant risk factor. Once PBH has been diagnosed, medical nutrition therapy should be the first step in management.…”

Section: Strategies Following Surgerymentioning

confidence: 99%

Strategies to Maintain the Remission of Diabetes Following Metabolic Surgery

Kim,

Kim

2023

J Metab Bariatr Surg

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Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). Bariatric surgery is the most effective means of inducing weight loss, and can ameliorate or induce the remission of obesity-related metabolic comorbidities, including T2DM. The guidelines for the management of T2DM emphasize weight management and recommend metabolic surgery for the treatment of T2DM accompanied by obesity. However, despite the clear beneficial effects of metabolic surgery, only 20–50% of patients who experience remission will stay in remission over the long term. Moreover, the beneficial effects of metabolic surgery tend to diminish with time, and a subset of patients experience a relapse of their diabetes. Therefore, in the present review, we discuss potential strategies for the maintenance of diabetic remission following metabolic surgery.

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Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

Cited by 16 publications

References 49 publications

Insulinoma Misdiagnosed as Post-bariatric Hypoglycemia: A Case Report and Review of the Literature

Insulinoma Misdiagnosed as Post-bariatric Hypoglycemia: A Case Report and Review of the Literature

Caso de hipoglicemia severa posterior a desviación gástrica en una mujer con enfermedad por esteatosis hepática no alcohólica (EHGNA)

Strategies to Maintain the Remission of Diabetes Following Metabolic Surgery

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